CRIC

Emergency cricothyrotomy tool optimized for pre-hospital scenarios.

It is familiar just like a syringe, giving paramedics confidence to perform an otherwise complicated procedure.

Cricothyrotomy is last resort procedure to establish an airway in certain life life-threatening cases, such as massive facial trauma. Surgical cricothyrotomy, where a scalpel is used to provide ventilation through an incision on the trachea, is the most effective procedure, but it is highly invasive. It requires a high level of skill, experience and optimal controlled working conditions. The needle cricothyrotomy on the other hand, which is a procedure preferred by paramedics, is where a cannula is placed in the trachea through a needle from a syringe. It is easier to perform and preferred by the paramedics for several reasons, but also because of their daily experience of handling syringes. However, this method does not provide as effective ventilation due the small diameters of the cannula.

Cric is a single-use cricothyrotomy tool that combines the advantages of the needle and surgical cricothyrotomy in a designed form optimized for a pre-hospital context. It provides confidence for pre-hospital health professionals to choose surgical cricothyrotomy instead of less effective procedures. It minimizes the necessary skill and experience required to perform an otherwise complicated procedure.

2015 | Individual Work | 10 weeks

in collaboration with Laerdal Medical & Umea Ambulance Station

IF Design Talent 2017, IDEA 2016 Finalist

''These cases are not so often, we only had one case in the last five years.'''' I used the needle method because it is easier.''

Kristofer Östenson, Paramedic

Ambulansstation Umeå ,19.10.2015

Why paramedics prefer to use needle cricothyrotomy although it doesn’t provide proper ventilation?

The Challenge | Procedure Aspect

Since the patient’s airway is blocked, this procedure needs to be performed quickly. On the other hand, it is like a two-edged sword. It needs to be quick but precise. There are many steps each requiring attention. It might become challenging even for surgically trained personnel with the time pressure added.

The Challenge | Human Aspect

Paramedics feel uncomfortable using a scalpel because it is not one of their daily tools. The severity of the cases requiring this procedure causes a lot of stress and pressure on them. Since these cases are rare, it is a high possibility that a paramedic is performing this procedure for the first-time in context.

The Challenge | Context Aspect

An emergency scene or a moving ambulance is nothing close to a surgery room. There might be no helping hands available and keeping multiple tools sterile is almost impossible. This makes performing this procedure even more challenging.

''I have seen a number of successful emergency cricothyrotomies where the patient ended up brain dead.''

Prof William Griggs

One hand operation

The product and sterilization wipe are packaged together. When it is stripped off from the top, the sterilization wipe is reached before the product itself, which decreases the risk of contamination of the tool while sterilizing the operation area. The protective cap sealed to the package stays in packaging, and Cric is ready to use. With the scalpel accommodating pre-loaded catheter, it offers one hand operation giving the possibility to perform the procedure quickly without the need of helping hands and to use non-dominant hand to stabilize trachea. CRIC’s high contrasts colours make the sequence of actions cognitively clear to the user.

A familiar tool

One of the main insights from the user research was that paramedics were very skilled and aware that they must be able to improvise and sometimes perform drastic actions in the different emergency situations. With this reason, they like to understand their tools, take them apart if needed and use them in their own way. Besides, scalpel is not a familiar tool for paramedics. Based on this insight the CRIC was deliberately designed to be a manual and transparent tool. The aim was to keep the syringe metaphor, not only in the functionality but also in semantics so that the paramedics would feel as familiar with the solution despite it offers a totally new functionality.

Controlled Incision

With the regular scalpels, it is not easy to understand the depth of the incision which most of the time result in several incisions and complications. In the needle cricothyrotomy, as the plunger is pulled back while advancing the needle, the bubbles are observed in the barrel thanks to the positive pressure in the airways. Taking inspiration from this physical principle, Cric accommodates a depth control mechanism in order to make more controlled and precise incision.

Pre-loaded Catheder

The introducer head of the tube functions as a dilator so that the tube can be placed over the scalpel. By combining the incision and intubation steps, it is aimed to minimize the problems arising from losing the incision between two steps. The tube is guided by the scalpel. The elliptical form of the tube makes the dilation easier, while it fits better to the anatomy of the cricoid membrane.

Cric in Laerdal Airway Managment Product Family

PROCESS

Understanding the user and the context

As a group of 12 students, we have been in Västerbottens ambulance station, Umea/Sweden, for three days to get involved in the daily routine of the ambulance station. The small chats that we had during this time helped us to get to know them better as well as the interviews conducted. We also got a chance to join ambulance teams in 28 cases in total and got first-hand experience on-site.

Understanding the procedure and constraints

As it is nearly a surgical procedure, looking more into the anatomical restrictions and creating guidelines to follow was important for this project. As a result, the overall concept was more inside-out building upon those details. To understand the procedure itself and different kinds of cricothyrotomy, I have been looking into how it is done step by step. Ended up with a cricothyrotomy playlist on youtube with a lot of bloody videos 😀 | https://www.youtube.com/playlist?list=PLMBL7-nMtEsbV82mPsQxqcs7rL8a2XZhC